Check-form.



PATENTED MAR. 17, 1908.

W. H. BERTRAM.

CHECK FORM.

APPLIUATIpN FILED JULY 25. 1907.

Inde/11,5011' WILLIAM H. BERTRAM, OF SPRINGFIELD, MISSOURI.

CHECK-FORM.

Specification o! Letters Patent.

Patented March 17, A1908.

Application filed July 25, 1907. Serial No. 385,588.

To all whom it may conce-rn:

Be itknown that I, WILLIAM H. BERTRAM, a citizen of the United States, a resident of S )ringfield, in the county of Greene, State of ltiissouri, have invented new and useful Imrovements in Check-Forms, of which the folowing is a specification.

The object of my invention is to provide an im )roved check form for protection in the use oi bank and commercial paper such as drafts, checks, notes, etc.

The invention is embodied in a check form as hereinafter described, and shown in the accompanying drawings, which represents a plan view of a blank instrument filled out and directing the payment of a certain sum. A indicates the body of the instrument; A that portion of said body which includes the direction to pay a certain amount to a cer.

tain person etc. In this instance ysaid body A bears the number 1486, and is dated S ringfield, Missouri, February 14, 1907, and) directed to the Springfield Trust Com- )any/ which is ordered to Pay to John oe or bearer 89,876-T54-6, Nine thousand ei ht hundred and seventy-six dollars and ty -four cents, and signed Richard Roe. ment is a block or square A2, which is divided by ten vertical parallel lines spaced e uidistantly into eleven vertical spaces. Tile two lower horizontal rows or spaces are for the entr of cents, and accordingly. the sign C is p aced opposite each row. The lower row is for units,.and the second or the upper row for thousands. The horizontal rows or spaces above these are for the entry of dollars, and accordingly the usual $-sign is placed at the left, opposlte each row. The iirst lower row indicated by the dollar sign is for units, the next for tens, the third for hundreds, and the fourth for thousands. Between the several horizontal rows of blank spaces there is a series of horizontal rows of numerals which are used purely for identification, and never for indicatingl value.

On the left of the body of the instrument is a stub A3, upon which there is a block or square A4 that is identical with the described block or square A2, save that the horizontal s aces that are blank in Az are in this case filed with numerals from one to zero inclusive, the same being preferably arranged in a different order. Thus in the lower cent row, one reads the numerals from right to left beginning with one, and in the On the same body A of the instruwith the block or square Aprinted thereon,

when presented, may be .i entified by the corresponding rows of identit ing numerals. In this instance the order is or payment of $9,876.54. The maker of the instrument fills out the square A2-correspondingl thatv is to say, in the blank space indicate in the stub by the numeral 4 1n the lower, or unit, row for cents, he places the numeral 4, and in the second row for cents he laces the numeral 5 in the s ace indicated) by 5 on the stub; again he p aces the numeral 6in the unit row for dollars, the numeral 7 in the tens row for dollars, the numeral 8 in the hundreds row for dollars, and the numeral 9 in the top or thousands row for dollars. On the stub the several numerals 9, 8, 7, 6, 5, 4 indicating the sum to be paid may be indicated by crossing the corres ending numerals as indicated in the bloc or s uare A4. In order that there may be no mista re in the entry of dollars and cents in this manner Qn the respective blocks or squares, it is obvi ous that no numeral is repeated in any of the rows of the numerals indicating value. In other words, in each row the numerals run from one to zero, however they may be otherwise arranged.

On the stub appears in addition to the block or s uare A4 the following: Book A #1486, Serlal 1, and the same appears also on the body A of the instrument.

On the right hand end of the instrument is the block or square Ai which corresponds with the stub A3 in all )articulars and is a duplicate key or stub to e kept by the bank or person using the check form. This draft or stub is separable from the body by means of perforations a. The stub A3 is similarly separable from the body of the instrument by perforated lines a.

It is apparent that upon presentation of the -body of the instrument to the bank or other party directed to pay the sum indicated, the bank or other payer may ascertain whether the instrument has been raised or changed in any particular, by com aring the square A2 with the form A5 whie may be sent by mail.

The horizontal 4lines or identifying figures i or numerals on the several blocks or squares may be diierent in every two' instruments, but must, of course, correspond with each other on any iparticular instrument.

What I claim is:

The improved blank check form, com rising tWo duplicate stubs, each having a b ook er square formed by ten parallel vertical lines, horizontal rows of numerals from one to zero yarranged in the s aces thus provided and suitably desi nated ibi expressing value in centsand do ars from unity upward, and a series of 'rovvs of identifyin numerals arranged horizontallybetween tigre rows of numerals designated for indicating value, anda bod portion A having a suitable space designate or direction of payment of a certain sum, and also a block or square having horizontal rows of identifying numerals similar to those on the tWo duplicate'stubs, the spaces between each two rows oi' identifying numeralsbeing blank for entry oi figures or numerals for expressing the amount specified in the body of the instrument7 as described.

WiLLiAM H. BERTRAM.

WILLIAM H. Bim'rtnAM,4 this. 14th 'day' of` February, 1907..

J. T. WHITE.'y

LOLA VAN BUREN. 

